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Drugs of abuse such as cocaine produce excess dopamine; anti- psychotics damp down dopamine: both are similar in that they create an 'altered mental state'. They turn on, or they turn off, and both interfere with the brain.

Anti- psychotics are a 'third alternative'- beyond cure or disease. They reboot the brain into a sort of passive numbness. They are not healing schizophrenia, but producing an alternative to it.

The drug- centred scaffolding for prescriptions by psychiatrists would then seem the logical model (1).

To make out that schizophrenia is solely the result of a 'surfeit of dopamine' is simplistic and therefore potentially wrong. The same as most genetic and medical problems, schizophrenia is probably the result of many factors. At least David Taylor was perhaps dangerously honest when he admitted: 'Clozapine, as with other drugs, must be doing something specific and direct; it must have a mode of action, if only we knew what it was.' (2)

While we cannot define adequately the amorphous aetiology of schizophrenia, we do, pace Taylor, appear to know more about how anti- psychotics operate. We seem aware, from a text book such as Stahl's (3), about neurons, neurotransmitters, what receptors each individual drug- from aripiprazole to zuclopentixol- blocks, or partially blocks, whatever.

Surely, then, to focus on the drug a la Yeomans rather than on the disease...

Drugs of abuse such as cocaine produce excess dopamine; anti- psychotics damp down dopamine: both are similar in that they create an 'altered mental state'. They turn on, or they turn off, and both interfere with the brain.

Anti- psychotics are a 'third alternative'- beyond cure or disease. They reboot the brain into a sort of passive numbness. They are not healing schizophrenia, but producing an alternative to it.

The drug- centred scaffolding for prescriptions by psychiatrists would then seem the logical model (1).

To make out that schizophrenia is solely the result of a 'surfeit of dopamine' is simplistic and therefore potentially wrong. The same as most genetic and medical problems, schizophrenia is probably the result of many factors. At least David Taylor was perhaps dangerously honest when he admitted: 'Clozapine, as with other drugs, must be doing something specific and direct; it must have a mode of action, if only we knew what it was.' (2)

While we cannot define adequately the amorphous aetiology of schizophrenia, we do, pace Taylor, appear to know more about how anti- psychotics operate. We seem aware, from a text book such as Stahl's (3), about neurons, neurotransmitters, what receptors each individual drug- from aripiprazole to zuclopentixol- blocks, or partially blocks, whatever.

Surely, then, to focus on the drug a la Yeomans rather than on the disease could be described as more rational.

Anti- psychotics are not a hundred per cent miracle. The ugly side effects- movement disorders and the metabolic syndrome- might account for the dreaded non- compliance that psychiatrists ascribe to lack of insight. Anti- psychotics stem from the dopamine theory of schizophrenia, a broad brush hypothesis. Articles such as that by Yeomans put the anti- psychotics under the spotlight- thus to emphasise all the flaws, all the errors, inevitable in cynical therapy that is only about prescriptions, only about drugs.